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RECAP 


The  Progress  of  Surgery 

as  Influenced  by 

Vivisection 


BY 


W.  W.  KEEN,  M.  D.,  LL.  D., 

Professor  of  the  Principles  of   Surgery   and   of   Clinical   Surgery, 
Jefferson  Medical  College,  Philadelphia. 


QUS, 


Js^3 


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College  of  3^\^v^itmm  anJi  burgeons; 
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The  Progress  of  Surgery  as  Influenced  by 

Vivisection 

BY 

W.  W.  KEEN,  M.  D.,  L  L  D.,  F.  R.  C.  S.  (HON.) 

Professor  of  the  Principles  of  Surgery  and 

of    Clinical     Surgery,     Jefferson     Medical 

College,  Philadelphia. 


^ 


Reprinted  from   "The   Philadelphia  Record"  of    September   14    and    21,   1901, 


5" 


THE  PROGRESS  OF  SURGERY    AS   INFLUENCED    BY 

VIVISECTION 


PART   1 


I  have  boen  asked  by  the  editor  of 
"The  Philadelphia  Record"  to  write  a 
brief  resume  of  the  influence  of  vivisec- 
tion on  the  progress  of  modern  surgery. 
I  shall  do  so  as  briefly  as  I  possibly  can, 
stating  only  facts  which  are  generally 
well  known  to  surgeons,  but  of  which 
the  general  public  of  necessity  must  be 
ignorant  to  a  great  extent.  Most  of  the 
facts  below  stated  are  known  to  me  per- 
sonally, as  they  have  occurred  during  my 
professional  lifetime;  and  I  can,  there- 
tore,  vouch  for  their  accuracy. 

Tf  a  physiologist  were  asked  to  con- 
tribute a  similar  paper  he  would  be  able 
to  tell  a  similar  story  as  to  the  revela- 
tions of  the  functions  of  various  organs 
in  the  human  economy  obtained  through 
vivisection;  if  a  professor  of  pharmacol- 
ogy (i.  e.,  the  action  of  drugs  upon  the 
living  body)  were  to  write  a  similar  pa- 
per he  would  be  able  to  show  an  equal 
debt   owing  to   animal   experimentation, 


first  in  giving  us  an  exact  knowledge 
of  the  action  of  drugs,  and,  second- 
ly, in  the  introduction  of  a  large  num- 
ber of  new  drugs.  In  this  way  cocaine 
was  introduced  into  medicine  and  the 
proper  use  of  such  a  powerful  drug  as 
digitalis   was   shown. 

If  a  medical  man  were  to  write  a  sim- 
ilar chapter  he  would  scarcely  know 
where  to  begin.  The  whole  life  history, 
for  example,  of  the  trichina  has  been 
studied  in  animals  and  the  results  ap- 
plied to  man,  so  that  if  evpry  one  would 
heed  the  warning  no  one  need  die  from 
the  trichina  worm  in  pork.  This  has 
had  also  an  enormous  commercial  value, 
since  all  our  hog  products  are  exported 
on  condition  that  the  trichina  be  ex- 
cluded by  microscopical  examination.  In 
diphtheria  the  percentage  of  deaths  has 
been  reduced  in  Baltimore  from  about 
70  per  cent,  to  about  5  per  cent.  The 
saving  of  human  life  in  a  single  year  in 


New  York  has  beeu  I.IOO.  All  this  is 
flue  to  the  antitoxin  of  diphtheria,  which 
has  been  evolved  almost  solely  as  a  re- 
sult   of    animal    exiierimentation. 

Two  water  companies  in  London  in 
lS5o  experimented  on  500.000  human 
beings,  and,  as  a  result  of  the  cholera, 
one  of  them  killed  3470  human  beings. 
In  that  same  year  Thiersch,  in  Leipzig, 
experimented  on  tifty-six  mice.  Had 
the  lesson  of  these  few  mice  been  heeded 
the  lives  of  these  human  beings  might 
have  been  saved.  More  than  that,  even 
at  the  present  day,  as  a  result  of  Koch's 
discovery  of  the  cause  of  cholera.  Haff- 
kine,  in  India,  is  making  protective  inoc- 
ulations which  are  proving  of  the  great- 
est value.  By  the  same  method  we  have 
recently  discovered  that  the  bubonic 
plague  is  spread  by  rats,  and  that  effica- 
cious vaccines  can  be  usc^  against  this 
dreadful  disease:  that  the  malarial  para- 
site is  spread  by  mosquitoes,  as  proved 
by  studies  both  in  birds  and  in  human 
beings;  and  the  preventive  inoculations 
against  typhoid  (as  yet  in  the  early  stage 
of  their  use)  have  been  discovered  by  the 
same  means. 

On  the  border  line  between  medicine 
and  surgery  is  the  new  science  of  bac- 
teriology. In  surgery  this  has  shown  the 
cause  of  erysipelas,  of  inflammation,  of 
tetanus  or  lock-jaw,  of  glanders,  of 
tuberculosis  (not  only  of  the  lungs,  but 
of  the  brain,  the  bones,  the  joints,  the 
bowels,  etc.)  and  of  many  other  disor- 
ders. 

Let  me  give  one  illustration  of  the 
method  by  which  the  cause  of  one  dis- 
ease—tuberculosis— was  proved.  Similar 
methods  are  employed  in  tracing  the 
causes  of  others.  In  a  case  of  consump- 
tion of  the  lungs  the  expectoration  is 
examined  by  the  microscope  after  apply- 


ing a  staining  material.  Without  stain- 
ing the  tubercle  baeilli  are  so  trans- 
lucent (like  little  rods  of  jelly)  that  we 
can  scarcely  see  them.  Having  found 
this  peculiar  germ  in  the  expectoration, 
some  of  the  material  is  injected  under 
the  skin  of  a  guinea  pig.  After  a  cer- 
tain time  the  animal  either  dies  or  is 
killed,  and  a  post-mortem  examination 
is  made.  I::'  there  are  found  in  the  body 
of  the  guinea  pig  little  nodules — i.  e.,  tu- 
bercles (little  tubers) — these  are  exam- 
ined by  the  same  method  and  the  same 
germs  will  bt  discovered  and  can  be  ob- 
tained in  a  pure  culture.  But  the  cir- 
cle of  proof  is  not  yet  complete.  A 
small  portion  of  this  pure  culture  of  the 
germs  obiained  from  the  inoculated 
guinea  pig  is  again  injected  into  another 
an;mal,  and  if  the  second  animal  suffer 
from  a  similar  disease  and  the  same 
germ  be  found  again  the  conclusion  is 
irresistible  that  the  cause  of  the  tuber- 
culosis is  the  peculiar  germ  always 
found  in  such  cases. 

I  well  remember  the  incredulity  with 
which  I  first  read  of  the  origin  of 
lock-jaAv  from  the  soil,  but  very  soon 
this  incredulity  was  changed  to  belief 
in  the  face  of  absolute  demonstration 
after  this  fashion:  It  had  been  well 
known  for  years  that  hostlers,  cavalry- 
men, farmers  and  persons  who  were  en- 
gaged in  any  occupation  about  horses 
were  peculiarly  liable  to  lock-jaw. 
After  the  discovery  of  the  bacillus  of 
Icck-jaw  in  1884.  by  Nicolaier.  when  a 
case  of  lock-jaw  occurred,  the  ground 
on  which  the  patient  had  fallen,  or  the 
instrument  by  which  he  had  beeu  hurt, 
was  examined,  and  a  certain  bacillus 
was  found  in  or  on  it.  This  was  inoc- 
ulated into  animals,  and  was  found  to 
produce  the  same  disorder;  and  the  same 


bacillus  was  recovered  from  the  ani- 
mal's body,  aud  was  reinoculated.  The 
circle  of  proof,  therefore,  was  complete. 
This  explained  the  popular  belief  that 
treading  on  a  rusty  nail  is  a  frequent 
cause  of  lock-jaw:  not  because  it  was 
a  nail  or  old  or  rusty,  but  because  the 
germ  of  lock-jaw  was  on  it  and  in  the 
ground  in  which  it  was  lying.  No  such 
exact  experiments  are  justifiable  on 
man.  The  sacrifice  of  a  few  rats  quick- 
ly gave  us  all  the  desired  information. 
This  has  abolished  lock-jaw  as  a  result 
of  surgical  operations,  and  enabled  us 
to  cure  it  in  many  cases  even  after 
accidental  inoculation.  Before  1884 
it  was  both  frequent  and  fatal;  now  it 
is  almost  a  surgical  curiosity,  except 
after  neglected  accidents. 

The  two  most  important  surgical  dis- 
.coveries  of  the  Nineteenth  Century 
were,  (1)  anesthesia,  especially  by 
ether  (in  1846)  and  by  chloroform  (in 
1847);  and  (2)  antisepsis,  by  Lord  Lis- 
ter, who  began  his  work  soon  after  the 
middle  of  the  Nineteenth  Century  and 
had  distinctly  formulated  it  about  the 
end  of  the  60's.  His  remarkable  paper 
in  The  Lancet  of  April  3,  1869  (when  he 
was  simply  Mr.  Lister,  Professor  of 
Surgery  in  the  University  of  Glasgow), 
was  one  of  those  papers  which  marked 
a  new  era  in  surgery.  Several  years 
before  he  had  announced  that  he  be- 
lieved that  infiammation  and  most  of 
our  surgical  disorders  were  due  to 
germs,  and  that  if  we  could  exclude 
these  germs  we  would  be  able  to  secure 
the  heahng  of  wounds  without  inflam- 
mation and  without  the  formation  of 
pus  (matter);  yet  it  was  not  until  1881 
that  Ogston  and  Rosenbach  discovered 
the  germs  which  produce  the  terrible 
results    of    inflammation,    such    as    ery- 


sipelas, hospital  gangrene  (what  irony 
in  the  name  I)  abscesses,  blood  poison- 
ing and  even  death. 

HEMORRHAGE. 

One  of  the  most  important  contribu- 
tions by  Lister  to  the  progress  of  sur- 
gery was  the  introduction  of  antisep- 
tic threads  (ligatvires)  of  catgut,  with 
which  to  tie  blood  vessels.  One  of  the 
earhest  Philadelphia  surgeons,  Philip 
Syng  Physick.  tried  to  get  rid  of  the 
dangers  following  silk,  which  had  been 
used  to  tie  arteries  ever  since  Ambroise 
Pare  introduced  it  in  the  Sixteenth  Cen- 
tury as  a  happy  substitute  for  the 
horrible  hot  pitch  and  hot  iron  which 
then  were  the  only  means  for  arresting 
hemorrhage,  Physick  sought  to  use 
buckskin,  on  the  ground  that  it  was 
an  animal  substance  and  would,  there- 
fore, disappear  by  absorption.  Dorsey 
used  catgut.  Hartshorne  used  parch- 
ment cut  in  fine  threads,  and  Bellin- 
ger and  Eve  the  tendon  of  the  deer.  But 
none  of  these  surgeons  succeeded  in  giv- 
ing us  harmless  ligatures  until  Lister 
taught  us  how  to  use  them.  In  the 
paper  which  I  have  referred  to  he 
showed  that  the  old  idea  of  a  ligature 
was  that  it  was  a  foreign  body  which 
was  to  be  got  rid  of  by  its  rotting 
through  the  walls  of  the  blood  vessel. 
The  result  was  that  in  a  very  large  per- 
centage of  cases  the  blood  vessel  was 
not  stopped  by  a  clot;  secondary  hemor- 
rhage took  place  (usually  during  the  sec- 
ond week  after  an  operation),  and  many 
a  patient  bled  to  death. 

I  shall  never  forget  one  night  in  the 
Satterlee  Hospital,  of  West  Philadel- 
phia, about  ten  days  after  the  battle  of 
Gettysburg,  when  I  was  called  five  times 
to  check  just  such  secondary  hemorrhage 
from    the    rotting    through    of    silk    liga- 


tures.  As  a  eoiiseqiience  of  the  introduc- 
tion of  antiseptic  ligatures  by  Lister  I 
do  not  recall  in  the  last  twenty  years  five 
cases  similar  to  these  five  that  I  then 
attended  in  one  night.  In  other  words, 
secondary  hemorrhage  has  almost  disap- 
peared from  surgical  experience. 

How  did  Lister  find  out  the  proper 
method  of  tying  an  artery?  On  Decem- 
ber 12,  1867,  he  tied  the  great  carotid 
artery  in  the  neck  of  a  horse  with  a 
piece  of  pure  silk  saturated  with  a  strong 
watery  solution  of  carbolic  acid,  cutting 
both  ends  of  the  thread  short  and  dress- 
ing the  wound  antiseptically.  Healing 
took  place  without  any  inflammation. 
Six  weeks  after  the  operation  he  investi- 
gated the  parts  by  dissection,  and  found 
that  if  the  thread  had  not  been  applied 
with  the  antiseptic  precautions  secon- 
dary hemorrhage  would  unquestionably 
have  occurred,  and  in  all  probability  the 
animal  would  have  bled  to  death.  On 
January  29,  18b8,  he  applied  this  prin- 
ciple in  the  case  of  a  woman  of  fifty-one 
^\ith  an  enormously  dilated  sac  (an 
aneurism)  in  the  upper  part  of  the  great 
artery  supplying  the  thigh  and  leg.  She, 
like  the  horse,  recovered  without  in- 
flammation, and  lived  for  ten  months. 
On  November  30  she  suddenly  died  as 
the  result  of  a  rupture  of  a  similar  dilata- 
tion of  the  aorta  in  the  ch<^st.  This  gave 
Lister  the  unusual  opportunity  of  exam- 
ining in  a  human  body  the  result  of  his 
application  of  an  antiseptic  thread  to 
the  arteries.  The  case  emphasizes  one 
of  the  great  difficulties  in  studying  such 
questions  on  human  beings.  The  oppor- 
tunity for  a  post-mortem  examination 
after  such  an  application  of  a  new  prin- 
ciple can  only  be  occasional.  If  this 
woman  at  the  time  of  her  death  had 
been  under  the  care  of  some  other  sur- 


geon than  Lister  no  such  carf^ful  exam- 
ination of  the  consequences  of  the  tying 
of  the  artery  would  have  been  made,  and 
no  further  progress  would  have  followed. 
The  result  of  his  examination  showed 
that,  in  spite  of  his  care,  an  incipient 
abscess  was  developing  at  the  point  at 
which  he  had  tied  the  artery.  This  was 
in  consequence  of  the  presence  of  the 
thread,  and  especially  of  the  knot. 

As  a  result  of  this  investigation,  on 
December  31,  18()8,  he  tied  the  carotid 
artery  in  the  neck  of  a  calf  with  catgut 
which  had  been  prepared  with  carbolic 
acid,  and  all  antiseptic  precautions  were 
used  during  the  operation.  The  calf 
recovered  perfectly,  and  in  thirty  days 
was  killed  and  the  parts  dissected.  He 
found  that  at  the  site  of  the  thread  of 
catgut  there  was  a  band  of  living  tissue 
surrounding  the  thread  and  closing  the, 
artery,  and  that,  therefore,  instead  of 
the  thread  rotting  through,  as  was  the 
case  Avith  the  silk,  it  had  become  a  part 
and  parcel  of  the  tissues.  The  artery, 
instead  of  being  so  weakened  as  to  al- 
low of  secondary  hemorrhage,  was  really 
stronger  at  this  point  than  at  other 
points.  The  ligature  and  the  knot  had 
entirely    disappeared. 

I  have  narrated  this  somewhat  in  de- 
tail for  this  reason:  It  illustrates  ad- 
mirably the  method  of  scientific  prog- 
ress by  experiment  upon  animals.  Neither 
of  these  animals  suffered  any  material 
pain,  both  operations  having  been  done 
with  the  same  antiseptic  care  as  in  a 
human  being.  Both  of  them  were  killed 
at  such  a  time  as  would  facilitate  our 
knowledge  of  the  results. 

Since  then  other  experimenters  have 
tied  the  blood  vessels  in  animals  and 
have  killed  them  at  varying  intervals 
and  made  microscopical  examinations  of 


the  blood  vessels.  lu  this  manner  our 
knowledge  of  the  way  in  which  hemor- 
rhage is  stopped  is  now  complete.  Ihe 
Knowledge  which  was  attained  within  a 
.short  time  by  the  sacniice  of  a  few 
animals  would  have  been  attained  only 
alter  many  years  by  occasional  post-mor- 
lems,  and  would  then  have  been  very 
much  less  periectly  attained  and  only 
by  the  loss  or  many  human  hves  instead 
of  a  few   animals'   lives. 

Contrast,  now,  the  result  of  the  old  and 
the  new  surgery  in  tue  mere  matter  of 
stopping  hemorrhage  after  operations  or 
accident  by  tying  blood  vessels  with  the 
old  ordinary  silK  and  the  modern  anti- 
septic catgut,  or  with  silk  itself  as 
now  tised  by  improved  methods.  In  the 
old  way  the  blood  vessels  were  tied  with 
silk,  which  was  as  clean  as  an  ordinary 
housew'ife  would  have  it.  One  end  was 
left  long,  and  it  was  no  uncommon  thing 
after  an  amputation  of  the  thigh  to  have 
as  many  as  twenty  or  thirty  of  these 
ligatures  or  threads  hanging  out  of  the 
wound.  After  two  or  three  days,  when 
those  on  the  smaller  blood  vessels  would, 
possibly,  be  rotted  through,  each  liga- 
ture was  pulled  upon,  and  those  that 
were  already  loosened  by  putrefaction 
came  away.  Finally,  at  the  end  of  ten 
days,  two  weeks  or  three  weeks,  the  lig- 
ature on  the  great  blood  vessel  of  the 
arm  or  thigh  came  away,  not  uncom- 
monly followed,  as  has  been  stated,  by 
profuse  and  often  fatal  hemorrhage. 
Sometimes,  as  in  Lord  Nelson's  case, 
such  a  ligature  did  not  rot  away  for 
years,  and  required  dressing  of  the  arm 
all  of  this  time  on  account  of  the  con- 
stant discharge. 

What  happens  to-day  in  a  surgical 
operation  where  either  properly  prepared 
silk    or    catgut    is     used?      We    tie   all 


the  blood  vessels  needing  it,  cut  off 
both  ends  of  the  threads  shoii:  and  close 
the  wound  entirely;  and,  instead  of  hav- 
ing discharge  and  horrible  inflamma- 
tion for  days  and  often  weeks  and  some- 
times months,  it  is  now  a  rare  thing  for 
such  a  wound  not  to  be  entirely  healed 
within  ten  days,  and  sometimes  less,  and 
secondary  hemorrhage  is  almost  unheard 
of.  If  .vivisection  had  given  to  surgery 
only  the  modern  means  of  stopping  hem- 
orrhage it  would  be  worth  all  the  labor 
it  has  required  and  all  the  suffering  it 
has  inflicted  on  all  the  animals  ever 
experimented  upon. 

Of  late  a  new  problem  in  hemorrhage 
has  been  presented.  When  an  artery  is 
wounded — as,  for  instance,  if  the  blade 
of  a  pocket  knife  has  been  thrust  into 
the  thigh  and  wounds  the  great  femoral 
artery— the  only  way  to  prevent  the  pa- 
tient's bleeding  to  death  has  been  to 
expose  the  artery  and  tie  it  above  and 
below  the  point  where  it  was  cut.  Of 
late  several  surgeons  (especially  Mur- 
phy, of  Chicago)  have  made  some  very 
ingenious  experiments  on  such  wotmded 
blood  vessels.  They  have  carefully  ex- 
posed the  artery  of  an  animal  (under  an 
anesthetic,  of  course),  have  wounded  it, 
and  then,  instead  of  tying  the  artery, 
have  sewed  up  the  wound  in  the  wall 
of  the  artery  to  see  whether  this  could 
not  be  done  successfully.  The  reason 
for  this  series  of  experiments  is  this: 
When  we  cut  off  the  supply  of  blood  to 
a  leg  or  an  arm  by  tying  the  blood  res- 
sel,  gangrene  not  uncommonly  occurs,  be- 
cause the  chief  blood  supply  of  the  limb 
is  cut  off  by  tying  the  artery.  If  in- 
stead of  tying  the  vessel  we  can  sew  up 
the  wall  and  it  will  heal,  the  current  of 
blood  is  uninterrupted  and  there  is  no 
danger  of  gangrene.     One  thing  is  per- 


fectly  manifest— it  would  never  be  prop- 
er to  make  such  experiments  on  human 
bemgs.  Human  life  would  be  endan- 
gered, and  no  surgeon  would  adopt  or 
would  be  justified  in  adopting  such  a 
novel  procedure  until  it  had  been  tried 
and  proved  successful  on  animals.  Sev- 
eral successful  cases  of  suture  (sewing) 
of  the  large  blood  vessels  have  now  been 
done  in  man. 

THE    BRAIN. 

\Yhen  I  first  taught  anatomy,  thirty- 
five  years  ago,  the  various  portions  of 
the  brain  were  not  supposed  to  have 
separate  functions.  We  knew,  of  course, 
that  disease  or  an  injury  on  one  side 
of  the  head  produced  paralysis  on  the 
opposite  side  of  the  body.  Broca  also 
discovered  by  observations  on  man  in 
actual  cases  of  disease  that  when  that 
part  of  the  brain  corresponding  to  the 
left  temple  was  affected  the  power 
of  speech  was  lost.  But  if  a  man  had 
a  fracture  of  the  skull  or  a  gun-shot 
wound  in  the  region  above  the  ear  or  in 
the  front  of  the  brain  or  the  back  of  the 
brain,  there  was  no  well  recognized  dif- 
ference in  the  results.  This  was  largely 
due  to  the  fact  that  such  injuries  are 
widespread,  and  not  limited  to  small 
areas.  In  Germany  Fritsch.  Hitzig  and 
Goltz,  and  in  England  Horsley,  Ferrier. 
Schaeffer  and  others,  pursued  the  fol- 
lowing plan:  The  monkey's  brain  is  the 
nearest  in  similarity  to  man's.  A  known 
portion  of  the  brain — for  instance,  the 
region  above  the  ear — being  exposed,  the 
brain  was  mapped  out  in  small  squares 
and  each  one  of  these  squares  in  suc- 
cession had  the  pole  of  a  battery  applied 
to  it.  The  phenomena  which  occurretl — 
whether  opening  and  shutting  the  eyes, 
turning  the  head  right  or  left,  contrac- 
tion of  the  muscles  of  the  arm  or  leg — 


were  all  carefully  noted  down.  In  this 
way  a  distinct  map  of  the  brain  was 
made,  so  that  we  know  definitely  that  a 
certain  area  of  the  surface  of  the  brain 
governs  the  movements  of  the  eyes,  of 
the  head,  of  the  arm,  forearm,  hand, 
thumb,  thigh,  leg,  great  toe,  etc.  In  the 
same  way  at  the  back  of  the  head  the 
area  which  governs  sight  has  been  found, 
and  it  was  discovered  that  the  area  on 
the  right  side  if  destroyed  made  the  right 
half  of  each  eye  blind,  and  that  if  the 
area  of  the  left  side  was  destroyed  the 
left  half  of  each  eye  became  blind.  This 
description  is,  probably,  sufficient  to 
indicate  how  physiologists  and  surgeons 
have  investigated  the  brain. 

The  following  is  an  instance  which 
shows  how  accurately  this  method  has 
enabled  us  to  locate  the  motor  centres 
in  the  brain.  A  girl,  who  suffered  from 
epilepsy,  and  in  whom  the  convulsions 
always  began  in  the  right  thumb,  and 
then  spread  to  the  arm  and  the  body, 
was  operated  upon.  A  piece  of  the 
gray  matter  of  the  brain,  as  large  as 
the  last  joint  of  the  forefinger,  was  re- 
moved from  the  place  determined  upon 
animals  as  the  centre  governing  the  move- 
ments of  this  thumb.  When  she  awoke 
from  the  ether  that  thumb  was  entirely 
paralyzed,  and  no  other  part  of  the 
body.  When  we  remember  that  the 
muscles  which  move  the  thumb  arise  in 
the  ball  of  the  thumb,  between  the 
thumb  and  the  forefinger  and  on  the 
front  and  the  back  of  the  forearm  nearly 
as  high  as  the  elbow,  this  is  seen  to 
be  most  remarkable.  I  do  not  know 
a  single  case  ever  recorded  of  so  minute- 
ly located  disease.  By  no  other  means 
than  vivisection  could  this  small  thumb 
centre  have  been  determined.  She  has 
entirely    recovered    from    the    paralysis, 


and  her  epileptic  fits  instead  of  being 
almost  daily  were  reduced  to  one  or 
at  the  most  two  a  year.  This  has  made 
possible  the  modern  surgery  of  the  brain, 
which  would  not  exist  to-day  were  it  not 
for  vivisection. 

Here  and  there  an  unexpected  post- 
mortem examination,  as  in  the  case  of 
Lister's  woman  patient,  has  given  us 
some  special  information,  but  nine-tenths 
if  not  ninety-nine-one-hundredths  of  our 
knowledge  of  cerebral  localization  is  th-o 
result  of  exact  experiment  on  animals. 
As  a  consequence  of  this  in  1884,  for 
the  first  time  in  the  history  of  surgery, 
the  existence  of  a  tumor  of  the  brain, 
which  was  not  indicated  by  anything  on 
the  outside  of  the  head,  was  diagnosti- 
cated, its  location  determined  and  the 
tumor  removed.  When  the  skull  was 
opened  no  tumor  was  visible:  but  so 
confident  was  Mr.  Godlee,  the  surgeon, 
that  he  cut  boldly  into  the  substance  of 
the  brain  and  there  found  the  tumor 
which  had  been  so  accurately  diagnos- 
ticated. Since  then  this  first  achieve- 
ment has  been  repeated  not  only  scores, 
but  hundreds  of  times,  and  the 
net  result  up  to  1898  was  that  273 
brain  tumors  had  been  operated  on.  Of 
the  patients  169  ((jl.9  per  cent.)  had  re- 
covered and  104  (38.1  per  cent.)  had  died. 
At  present  it  can  be  said  that  two  out  of 
every  three  recover!  This  localization  of 
cerebral  functions,  together  with  anti- 
sepsis, has  so  revolutionized  (or,  rather, 
created)  modern  cerebral  surgery  that 
the  principal  facts  are  a  matter  of  com- 
mon knowledge.  Tumors  are  now  at- 
tacked not  only  in  what  is  called  the 
motor  area  (that  is,  that  portion  of  the 
brain  governing  movement,  which, 
roughly  speaking,  may  be  described  as 
lying   above   the    ear),    but    many    times 


in  the  front  part  of  the  brain,  and  at  the 
back  of  the  brain,  far  outside  of  the 
UK^tor  area.  In  case  the  tumor  is  at  the 
base  of  the  brain,  or  at  certain  other 
party  this  knowledge  has  prevented  use- 
less operations  which  otherwise  might 
have  been  performed. 

It  is  a  source  of  sincere  gratification 
on  the  part  of  numerous  sureeons  that 
by  this^same  knowledge  of  cerebral  local- 
ization derived  from  animal  experimenta- 
tion they  have  been  able  to  recognize 
hemorrhage  inside  the  skull,  open  the 
skull  at  the  right  point,  even  when  there 
was  no  fracture,  and  save  their  patients. 
Before  experiments  on  animals  showed 
us  how  to  interpret  the  symptoms  this 
was  an  impossibility,  and  nearly  all  such 
patients  died.  Now"  we  save,  roughly 
speaking,  two  out  of  three! 

Time  and  space  would  fail  me  to  tell 
of  the  abscesses  of  the  brain,  of  the 
foreign  bodies  in  the  braiu  (such  as 
nails  driven  into  it  by  accident  or  de- 
sign, rifle  balls  which  had  lodged  in  it) 
and  of  many  other  similar  surgical  dis- 
orders the  modern  successful  treatment 
of  which  depends  directly  upon  the  lo- 
calization of  cerebral  functions,  which 
is  the  result  almost  wholly  of  experi- 
ments upon  animals. 

THE  SPINAL  CORD. 

Up  to  the  present  time  the  belief  of 
surgeons  has  been  that  in  case  the  spinal 
cord  was  completely  cut  in  two,  either 
by  gunshot  wounds,  fracture  of  the 
spine  or  otherwise,  no  reunion  of  the 
two  ends  would  take  place,  and,  there- 
fore, there  was  no  possibility  of  relief 
for  the  paralysis  below  the  point  of  di- 
vision of  the  cord  which  is  almost  al- 
ways fatal.  Only  this  winter,  at  the 
Pennsylvania  Hospital,  Dr.  Stewart  had 
a  patient  whose  spinal  cord  was  cut  in 


two  bv  a  bullet.  He  removed  the  bone 
sufficiently  to  get  access  to  the  spinal 
cord,  and  found  it  completely  divided. 
He  immediately  stitched  the  tAvo  ends 
together,  and,  strange  to  say,  this  pa- 
tient has  recovered  both  feeling  and 
motion  to  some  extent  in  both  legs.  I 
think  it  would  be  evident  to  any  person 
that  such  a  totally  unexpected  result  de- 
serves the  most  careful  investigation.  In 
man  cases  of  such  complete  division 
followed  by  recovery  are  almost  un- 
known; and  if  they  had  to  be  studied  in 
man  this  would  be  imperfectly  done, 
and  probably  would  require  fifteen  or 
twenty  years  before  we  would  know 
what  ought  to  be  done.  It  is  one  of 
those  cases  in  which  it  is  our  duty  to 
investigate  by  experiments  upon  animals 
what  is  the  best  method  of  sewing  the 
two  ends  of  the  spinal  cord  together:  at 
what  date  after  division  of  the  cord  it 
will  be  hopeless  to  do  so;  how  much  of 
the  cord  can  be  lost  (that  is  to  say,  a 
half  inch,  inch  or  more)  and  yet  by 
stitching  the  two  ends  together  it  will 
be  possible  to  restore  the  function  of 
the  spinal  cord.  One  can  see  very  read- 
ily that  in  animals  all  these  problems 
can  be  studied  minutely,  in  a  sufficient 
number  of  cases:  various  procedures 
can  be  tested  and  the  results  determined 
accurately  by  killing  such  animals  at  a 
suitable  date,  and  a  definite  conclusion 
can  be  reached  in  a  short  time. 

In  1888  Mr.  Horsley,  the  distinguished 
London  surgeon,  and  Dr.  Gowers, 
equally  distinguished  as  a  neurologist, 
for  the  first  time  in  the  history  of  sur- 
gery made  a  diagnosis  of  a  tumor  of  the 
spinal  cord,  definitely  located  it  and 
the  former  removed  it,  the  patient  mak- 
ing an  absolute  recovery.  A  number  of 
other  cases  have  been  successfully  oper- 
ated on  since  then.     Just  as  in  the  case 


of  tumors  of  the  brain,  this  would  not 
have  been  possible  had  it  not  been  for 
cxperim-ents  upon  animals,  which  have 
given  us  practically  most  of  our  pres- 
ent knowledge  of  the  minute  anatomy 
and  physiology  of  the  spinal  cord  and 
have,  therefore,  enabled  us  to  deal  with 
it  surgically. 

NERVES. 

Among  the  most  fruitful  branches  of 
reseai'ch  which  have  been  so  valuable 
in  results  are  the  animal  experiments 
upon  the  different  nerves  of  the  body. 
The  methods  by  which  nerves  could  be 
sewed  together;  the  possibility  of  taking 
a  portion  of  a  nerve  or  even  of  the 
spinal  cord  from  a  rabbit  or  other  ani- 
mal to  replace  a  piece  of  the  nerve  when 
it  has  been  destroyed  by  accident  or 
disease;  the  possibility  of  sewing  one 
nerve  to  a  neighboring  nerve  in  order  to 
re-establish  its  function — all  of  these 
and  other  similar  operations  have  been 
studied  in  animals,  and  could  only  be 
studied  in  animals  with  exactness. 

In  order  to  study  such  conditions  it 
is  not  enough  that  the  two  ends  of  the 
nerve  should  be  sewed  together  and 
then,  after  the  wound  has  healed,  that 
we  should  simply  determine  the  fact 
that  the  functions  of  the  nerve  are  re- 
established. It  is  necessary  to  know"  by 
the  microscope  the  various  steps  of  the 
process  of  union  of  the  nerves — to  in- 
vestigate various  methods  of  sewing 
them  together;  whether  they  can  be 
overlapped,  or  must  be  applied  exactly 
end  to  end;  whether  one  end  of  the  nerve 
can  be  split  and  the  other  inserted  into 
it,  or  turned  over  as  a  flap,  and  so  on. 
Evidently  numerous  methods  can  only 
be  studied  on  animals.  Then,  when  the 
results  are  known,  we  can  apply  them 
for  the  benefit  of  man. 


10 


THE   THYROID    GLAND. 

One  of  the  commonest  diseases  in  Eu- 
rope, and  one  that  is  occasionally  seen 
here,  is  goitre.  This  forms  a  large  tu- 
mor in  the  neck,  for  which  formerly  lit- 
tle could  be  done,  as  an  operation  was 
nearly  always  fatal.  Such  patients 
were  obliged  to  go  through  life  with  a 
dreadful  deformity,  in  the  greatest  dis- 
comfort, and  were  sometimes  suffocated 
by  pressure  on  the  windpipe.  In  con- 
sequence of  the  introduction  of  the  anti- 
septic method  of  Lister,  which  we  owe 
to  vivisection  more  than  to  any  other 
agency,  operations  on. the  thyroid  gland 
are  now  so  common  that  at  the  German 
Surgical  Congress  in  April  of  this  year 
Professor  Kocher,  of  Berne,  has  reported 
2000  operations  done  by  himself,  with 
a  mortality  of  only  four  per  cent. 

Very  soon  it  was  discovered  that  re- 
moval of  the  entire  gland  produced  a 
curious  effect.  The  face  became  bloated; 
the  expression  greatly  changed,  and  the 
patient  became  more  or  less  idiotic — that 
is,  the  condition  known  as  myxoedema 
followed.  This  led  to  improvement  in 
operations  in  several  directions.  First,  in 
all  those  cases  in  which  the  tumor  could 
be  shelled  out,  as  an  English  walnut 
is  turned  out  of  its  shell,  leaving  a  por- 
tion of  gland  tissue  behind,  this  was 
done.  The  similar  effects  of  the  removal 
of  the  thyroid  in  animals  were  studied 
especially  by  Mr.  Horsley.  Surgeons  then 
removed  the  thyroid  gland  from  the  neck 
of  an  animal  and  placed  it  under  the  skin 
of  the  same  animal,  and  it  was  found 
that  the  disastrous  results  were  avoided. 
After  a  number  of  experiments  on  ani- 
mals there  was  good  reason  to  believe 
that  the  disastrous  effects  of  the  opera- 
tion which  sometimes  followed  goitre 
could  be  avoided  in  man  by  the  same  pro- 


cedure. Accordingly  the  thyroid  gland 
of  a  sheep  w^as  transplanted  in  a  number 
of  instances  under  the  skin,  or  in  some 
cases  into  the  abdominal  cavity.  In 
both  cases  there  was  improvement  for 
a  time;  but  eventually  the  majority  of 
the  cases  suffered  from  cretinism  or 
myxoedema,  which  may  be  described  as 
a  less  severe  form  of  the  same  disease. 
Finally  in  animals  a  study  was  made 
to  determine  how  much  of  the  gland 
must  be  left  in  order  to  prevent  myxoe- 
dema, and  now  we  are  able  to  relieve 
patients  from  goitre  and  yet,  by  leaving 
enough  of  the  gland,  prevent  any  bad 
results   following  the  operation. 

These  results  led  also  to  a  careful 
study  of  the  effects  of  giving  an  extract 
of  the  thyroid  gland  to  human  beings. 
Some  of  the  most  brilliant  results 
that  have  ever  been  obtained  in  medi- 
cine have  followed  the  administration 
of  the  thyroid  extract  to  cretins  in  whom 
the  disease  had  not  been  produced  by 
operations  for  goitre,  but  arose  naturally. 
In  certain  forms  of  goitre  it  has  enabled 
us  to  relieve  or  even  to  cure  without 
operation.  In  insanity  and  many  other 
mental  states  it  is  used  as  a  well  estab- 
lished remedy,  which  in  even  a  large 
percentage  of  cases  is  followed  by  great 
benefit  and  often  by  cure.  In  many 
other  diseases  also  the  thyroid  extract 
has  been  used  with  the  best  results. 

REMOVAL.  OF   THE  LARYNX. 

Cancer  of  the  larynx,  or  that  part  of 
the  windpipe  back  of  and  just  below  the 
Adam's  apple,  is  not  at  all  uncommon. 
The  only  hope  of  such  patients  is  in  re- 
moving the  entire  larynx  or  voice  box. 
Before  attempting  this  for  the  first  time 
on  man,  Billroth,  of  Vienna,  and  his 
assistant  Czerny,  now  the  distinguished 


11 


Professor  of  Surgery  at  Heidelberg, 
tested  the  oiieratiou  on  several  dogs. 
Billroth  theu  removed  the  larynx  from 
his  patient  and  saved  his  hfe.  This 
operation  has  now  been  successfully  re- 
peated scores  and  scores  of  times  as  a 
result  of  these  few  experiments  on  dogs. 

THE  LUNGS. 

A  beginning  has  been  made  in  the 
surgery  of  the  lungs,  but  as  yet  we  have 
not  reached  the  point  where  we  can  say 
that  we  have  attained  entire  success. 
In  a  number  of  animals  parts  of  the 
lungs  have  been  cut  out  with  a  view  of 
discovering  the  possibility  of  cutting  out 
diseased  portions  of  lung,  the  seat  of  tu- 
mors, consumption  and  other  disorders, 
and  a  few  operations  have  been  done 
upon  man,  with  a  fair  percentage  of  suc- 
cess. Not  uncommonly  abscesses  of  the 
lungs  which  were  perfectly  inaccessible 
a  few  years  ago  have  been  reached  and 
opened.  Sometimes  coins  and  other  for- 
eign bodies  get  into  the  bronchial  tubes, 
and  can  only  be  reached  through  most 
difficult  and  dangerous  operations.  Sev- 
eral surgeons  have  experimented  upon 
animals  to  determine  the  safest  method 
of  removing  such  bodies,  but  with  only 
partial  success.  Is  it  not  evidently  our 
duty  to  devise  new  operative  procedures 
and  test  them  on  animals  first,  and,  when 
a  reasonably  promising  one  has  been 
found,  to  apply  it  to  man? 
THE  LIVER. 

In  1S90  Poufick,  of  Germany,  showed 
that  in  rabbits  the  removal  of  a 
quarter  of  the  liver  caused  a  slight  de- 
terioration in  the  condition  of  the  animal; 
removal  of  one-half  was  followed  by 
much  more  serious  symptoms,  which, 
however,  passed  off  within  a  few  days 
Even    removal    of    three-fourths    of    the 


Avhol(>  liver  could  be  recovered  from,  but 
removal  of  more  than  this  was  always 
fatal.  By  killing  the  animal  in  which  a 
small  part  had  been  removed  at  a  suit- 
able time,  and  studying  microscopically 
the  liver  tissue  at  ditterent  periods  of 
time  after  operation — a  procedure  mani- 
festly only  possible  in  animals — he 
showed  that  there  was  a  reparative 
power  in  the  liver,  which  before  then 
was  unknown. 

Up  to  that  date  less  than  a  dozen  sur- 
geons had  operated  on  tumors  of  the 
liver.  In  only  two  of  them  was  any 
considerable  portion  of  the  liver  re- 
moved. After  tiie  paper  by  Ponfick, 
which  showed  how  much  could  be  re- 
moved, surgeons  immediately  operated 
with  much  more  confidence,  and  removed 
considerable  portions  of  the  liver.  Up  to 
18yy  seventy-six  tumors  of  the  liver 
had  been  removed.  Of  these  cases  the 
termination  of  two  was  unknown;  of 
the  remaining  seventy-four  sixty-three 
recovered  and  eleven  died — a  mortality 
of  less  than  15  per  cent.  One  who  is 
not  a  surgeon  can  :jcarcely  appreciate 
how  differently  the  operation  for  tumor 
of  the  liver  was  regarded  before  and 
after  Ponfick's  experiments.  Before 
that  everything  was  marked  by  timidity; 
after  that  everything  was  marked  by 
confidence,  and  all  to  the  benefit  of  the 
patient. 

THE    SPLEEN. 

The  same  story  that  has  been  told  of 
the  liver  can  be  told  of  the  spleen, 
though  with  much  less  good  results. 
As  a  result  of  studies,  partly  by  acci- 
dent, in  man  (as  when  in  consequence 
of  a  stab-wound  or  other  injury  a  spleen 
would  protrude  through  the  wall  of  the 
abdomen,  and  would  have  to  be  re- 
moved),   but   chiefly   as  a  result  of  the 


careful  studies  of  removal  of  the  spleeu 
in  animals,  beginning  practically  with 
Schindeler's  experiments  in  ISTO,  we 
are  now  in  a  position  definitely  to  say 
that  m  man  the  whole  of  the  spleen  can 
be  removed,  and  he  can  not  only  sur- 
vive the  operation,  but  get  along  com- 
fortably without  any  spleen.  A  very 
considerable  number  of  such  operations 
have  now  been   successfully  performed. 

THE    KIDNEY. 

On  August  2,  1869,  Professor  Simon, 
of  Heidelberg,  laid  the  foundation  of 
the  modern  surgery  of  the  kidney  by 
removing  a  healthy  kidney  from  a 
healthy  woman.  The  reason  for  it  was 
that  in  removing  an  ovarian  tumor 
some  time  before  he  had  been  obliged 
to  remove  a  part  of  the  ureter  (the  tube 
leading  from  the  kidney  to  the  bladder), 
and  to  fasten  the  cut  end  to  the  skin. 
As  a  consequence  of  this  the  woman 
was  m  a  most  deplorable  condition  from 
the  continual  escape  of  urine  over  her 
person.  After  a  number  of  unsuccess- 
ful attempts  to  close  this  external  open- 
ing, it  finally  occurred  to  him  that  the 
only  way  to  cure  her  was  to  remove 
the  kidney  on  that  side.  Whether 
a  human  being  would  recover  and  could 
live  with  only  one  kidney  was  practically 
unknown.  It  is  true  that  disease  had 
destroyed  one  kidney  in  some  patients 
and  the  other  had  gradually  developed 
ability  to  do  the  work  of  both.  Injury 
also  had  destroyed  parts  or  all  of  one 
kidney,  but  deliberately  to  take  out  a 
healthy  kidney  from  a  healthy  human 
being  was  an  operation  not  only  fraught 
with  danger,  but  one  before  which  all 
the  surgical  world  up  to  that  time  had 


recoiled.  No  one  had  studied  the  effect 
on  the  remaining  kidney  and  upon  the 
heart.  No  one  had  carefully  determined 
what  was  the  best  method  of  reaching 
the  kidney— whether  through  the  ab- 
domen or  through  the  loin  from  the 
back;  what  to  do  with  adhesions  and 
many  other  technical  questions.  All 
these  had  to  be  settled.  Accordingly 
he  experimented  on  a  number  of  dogs; 
decided  that  from  these  indications  a 
Human  being  could  live  with  only  one 
kidney;  studied  on  the  cadaver  the  best 
way  of  doing  the  operation,  and  on 
August  2,  1869,  removed  this  healthy 
kidney  through  the  loin  and  saved  the 
patient's  life  and  made  her  perfectly 
comfortable.  She  died  in  1ST7,  after 
eight  years  of  healthy  life. 

As  I  have  said,  these  new  experiments 
laid  the  foundation  of  the  modern  sur- 
gery of  the  kidney.  Now  hundreds  of 
kidneys  have  been  removed  successful- 
ly. Finding  this  operation  so  feasible, 
surgeons  were  led  to  practice  other  oper- 
ations; some  hundreds  of  abscesses  in 
the  kidney  have  been  opened;  scores  of 
stones  have  been  removed  from  the  kid- 
neys; floating  (i.  e.,  loose)  kidney  has 
been  sewed  fast  in  hundreds  of  cases; 
many  cases  of  tuberculosis  of  the  kid- 
ney have  been  relieved  or  cured;  tu- 
mors of  the  kidney  are  successfully  at- 
tacked; even  the  cut  ureter  has  been 
spliced  and  stones  removed  from  it.  In 
a  word,  Simon's  experiments  on  a 
few  dogs  opened  to  us  a  new  domain  in 
surgery  which  until  then  was  wholly  un- 
known. Would  it  not  be  gross  cruelty 
to  man  to  prevent  such  beneficent  re- 
searches ? 


13 


THE    PROGRESS   OF  SURGERY   AS  INFLUENCED   BY 

VIVISECTION 


PART    11 


THE  STOMACH. 

Were  I  limited  to  the  progress  of  the 
surgery  of  the  stomach  alone  by  vivisec- 
tion there  would  be  quite  enough  ma- 
terial for  this  entire  paper.  Until  1875 
practically  there  was  no  surgery  of  the 
stomach.  As  occasional  Cassarean  sec- 
tions have  been  done  in  the  past,  so  oc- 
casional operations  on  the  stomach  were 
done  when  the  surgeon  was  obliged  to 
do  them.  Now,  however,  it  is  a  mat- 
ter of  routine  procedure,  to  the  vast 
benefit  of  the  human  race.  Had  vivi- 
section contributed  nothing  else  to  the 
progress  of  surgery  than  its  services  in 
the  surgery  of  the  stomach,  this  alone 
would  be  sutficient  to  justify  it.  I  may 
quote  from  the  Cartwright  lectures 
which  I  gave  before  the  College  of 
Physicians  and  Surgeons  in  New  York 
in  1898:* 


In  1875  Tschertneisky-Barischewsky  cut 
out  a  piece  of  the  intestines  in  35  dogs, 
with  29  recoveries— a  startling  result  when 
compared  with  the  former  fatality  of  such 
operations.  This  was  the  starting  point 
in  the  new  gastro-iutestinal  surgery.  The 
next  year  Gussenbauer  and  Winiwarter  cut 
out  a  piece  of  the  stomach  in  only  seven 
dogs.  We  scarcely  can  appreciate  at  this 
day,  though  these  experiments  are  so  re- 
cent, how  many  uew  questions  had  to  be 
answered.  After  their  first  unsuccessful 
experiment  they  naively  remark  that  cer- 
tain facts  were  established  by  the  experi- 
ment, among  them,  "that  the  surfaces  of 
the  stomach  have  a  real  tendency  toward 
union  by  first  intention,  .  .  .  just  as  do 
wounds  of  the  skin."  (!)  Whether  this 
would  be  correct  of  man  as  well  as  of  ani- 
mals they  admitted  was  as  yet  uncertain. 
Another  point  settled  bj'^  the  experiment 
was  "that  there  was  no  digestion  of  the 
mucous  membrane  in  the  neighborhood  of 
the  wound."  Their  second  experiment  was 
followed  by  recovery,  and  showed  not  only 
that  such  an  operation  could  be  successful- 
ly done,  but  that  the  narrowing  caused 
by    the    scar    did    not    interfere    with    the 


■In   quoting  this   I   have  popularized   some    of  the    medical   terms   there  used. 


14 


functions  of  the  stomach,  either  as  to  its  modern  surgerv.  Suffice  it  to  sav  that 
movement  or  its  secretion  of  the  digestive  ^i  ^i  ^  ,,  .  ,  . 
juices,  and  that  the  removal  of  the  pylorus  ^^ong  them  are  the  following,  all  of 
was  not  followed  either  by  th§  too  early  "which  owe  more  to  vivisection  experi- 
escape  of  tne  j.ood  into  the  intestines,  or  ments  than  to  anv  other  single  agencv 
by  the  reflux  of  the  intestinal  contents  into  -r„  „„„^„  ^-p  +i  -l,  •  \\ 
the  stomach.  The  dog  was  killed  five  ^^  cancer  of  the  a?sophagus  or  m  the 
months  later  and  the  post-mortem  showed  constriction  of  the  oesophagus,  which  so 
no  contraction,  by  reason  of  the  scar,  and  often  follows  the  accidental  or  intention- 
no  digestion  of  the  edges,  and  his  perfect  oi  swallowino- of  Ive  or  qr-ids  Atn  en  flmt 
health  after  the  operation  showed  that  the  ^^  ^^  ^^V^^  ^^^  °^  ^^^  °^  3.cias,  etc.,  so  that 
movements  of  the  stomach  and  its  digestive  ^^  food  can  get  into  the  stomach, 
functions  had  not  been  interfered  with,  we  no^  open  the  abdomen,  open  the 
Then  again,  the  question  whether  catgut  stomach,  introduce  a  tube  or  construct 
or  other  suture  material  was  the  best,  and  '  .  ^  u^  ulil-c  ui  cuushull 
what  kind  of  a  knot  and  what  kind  of  a  ^  passageway  into  the  stomach,  and 
suture  would  best  answer  were  subjects  of  feed  the  patient  through  this  outside 
debate.    •.•.-.  oesophagus,  as  it  were.  In  case  the  nar- 

Our  anti-vivisection  friends,  who  so  often  ^^^z^„    ^^    u.-u^    ^c^^i.o„,^    •  4.    .e 

declare  that  experiments  upoi  animals  have  rowing    of    the    oesophagus    is   not    from 

never  contributed  anything  to  the  progress  cancer  the  patient  can  live  his  natural 

of  surgical  science,  may  well  be  challenged  span  of  life.     In  case  of  cancer  his  re- 

to  account  for  the  remarkable  progress  in  maining    days    are    rendered    relativelv 
the   surgery   of   the   stomach   which   imme-  ^     t  -ui         -  ^x.  iciaLnei.v 

diately  followed  these  fruitful  experiments,  comfortable,    since  the       operation   pre- 

The  dogs   that   died   did   not   die  in   vain,  vents  his   starving  to  death.   When   we 

They  showed  the  correct  methods  and  indi-  have  cancer  at  the  opposite  end  of  the 

cated  errors  in  technic,  and  directly  led  up  stomach   (the  nvlonm'*    ^n  fhnt  th^  fanrl 

to  the  modern  surgerv  of  the  stomach  and  stomacn  ^tne  pyloiusj,  so  that  the  tood. 

the   intestine   in   man,    as   follows:    In   the  though  it  can  be  swahowed,  cannot  get 

very  same  year,  1876,  Hueter  cut  out  a  part  out  of  the  stomach,  one  of  two  courses 

?J_i^ebo^el,  though  without  success     In  jg   followed,    both   of   which   have   been 
18(<    Czerny   for   the   first   time   sewed   up  „   „        1   j-    i    •      mi       ■,  •       i 

the  intestine  and   dropped  it  into  the  ab-  carefully   studied  m  the   lower  animals 

dominal   cavity,    with    recovery;     followed  and   then    adapted   to    man.     First,    the 

almost   immediately   by   Billroth,    who   did  portion   of  the   stomach    and   bowel   in- 

the   first   successful   suture  of  the   stomach  ^^i^pd  in  the  cancer  is  cnf  nnt  nnrl  th^ 

and  total  removal  of  a  portion  of  the  bowel,  yo^^^ci  in  the  cancer  is  cut  out  and  the 

In  1878  Forelli  operated  for  a  wound  of  the  bowel  united  to  the  stomach  directly,  or, 

stomach,  and  in  1879  Cavazzani  removed  a  in   other  cases,   an   opening  is   made   in 

portion  of  the  stomach  for  tumor.    In  the  the  stomach  and  one  in  the  bowel  lower 

same  vear  Pean  did  the  first  removal  of  the  -,  ^  4.1,     j.  •  t 

pvloriis.    In  1880  Rvdvgier  did  the  second,  do^^i^'  and  the  two  openings  are  sewed 

and  in  1881  Billroth  did  the  third  and  first  together,  thus  allowing  the  food  to  pass 

successful  one,  without  a  knowledge  of  the  from  the  stomach  directly  into  the  bowel 

preceding  operations.  beyond  the  cancer.    The  mere  question 

Then  followed  various  operations  on  of  how  the  stomach  and  bowel  shall  be 

the  stomach  to  which  I  will  allude  later,  most  successfully  united  in  these  cases, 

and   finally   the    successful    removal    of  particularly  the  best  method  to  prevent 

the  entire  stomach.    It  is  quite  impos-  fatal      leakage,      has      required      very 

sible  to  give  the  details  of  all  the  vari-  many  series  of  experiments,   especially 

ous  operations  now   done  on  the  stom-  in  this  country,  by  Senn,  Abbe,  Brock- 

ach  and  indicate  minutely  the  part  that  aw,  Ashton,  Murphy  and  others.    As  a 

vivisection   has   had   in   developing  this  result  of  their  labors  sometimes  we  have 

extraordinarily     successful     branch     of  learned  how  not  to  do  the  operation  be- 

15 


cause  of  unexpected  difficulties:  some- 
times how  to  better  our  procedure,  un- 
til uow  Ave  are  in  possession  of  satis- 
factory methods,  as  has  been  proved  by 
the  successful  operations  on  man  many 
times  over.  Even  the  sewing  together 
of  the  stomach  and  bowel  alone  had 
been  done  up  to  1898  in  550  cases  which 
have  been  published.  I  have  no  doubt 
that  since  then  this  number  has  almost 
been  doubled.  The  mortality  of  this  op- 
eration from  1881  to  1885  was  05.71 
per  cent.;  from  1880-90,  the  mortality 
had  fallen  to  40.47  per  cent.;  from  1891 
it  had  again  fallen  to  33.91  per  cent., 
and  recently  in  twenty-seven  cases  an 
Italian  surgeon  (Carle)  has  had  a  mor- 
tality of  only  7.4  per  cent. 

^foreover,  the  experiments  on  ani- 
mals, having  shown  how  safe  various 
operations  are,  have  emboldened  us  to 
enlarge  the  sphere  of  our  operations  and 
do  others  that  were  before  not  dreamed 
of — a  good  instance  of  the  partly  indi- 
rect good  results  from  vivisection.  A 
brief  enumeration  of  some  of  the  vari- 
ous operations  done  upon  the  stom- 
ach, together  with  their  mortality,  is  as 
follows : 

(1)  Where  the  stomach  is  bound  down 
by  adhesions  (which  often  produce  the 
most  serious  digestive  disturbances,  de- 
stroying comfort  and  even  threatening 
life),  we  now  open  the  abdomen,  cut  or 
tear  the  adhesions,  and  practically  all 
of  the  patients  recover. 

(2)  AYhere  there  are  foreign  bodies  in 
the  stomach  (or  in  some  cases  foreign 
liodies  that  have  stuck  in  the  resophagus 
low  down,  near  the  stomach),  we  open 
the  stomach,  remove  the  foreign  body 
(often  inserting  the  entire  arm  to  reach 
it  in  the  (Je^^ophagus),  sew  up  ttie 
stomach  and  the  abdominal  wall,  and 
the  patients  generally  recover.    In  some 


cases  as  many  as  192  staples,  buttons, 
screws,  horse  shoe  nails,  etc.,  weighing 
over  a  pound  and  a  half,  have  been  re- 
moved, and  the  patients  have  recovered. 

(3)  Where  the  oesophagus  has  been 
narrowed  by  the  swallowing  of  lye,  etc., 
instead  of  making  a  permanent  opening 
in  the  stomach  (as  before  described), 
sometimes  by  having  the  patient  swal- 
low a  perforated  shot  which  will  carry 
a  string  down  into  the  stomach,  we  can 
open  the  stomach  temporarily,  seize 
and  draw  out  the  shot,  attach  a  coni- 
cal dilator  to  the  string,  and.  after  hav- 
ing dilated  the  constriction  of  the 
oesophagus,  remove  the  string,  sew  up 
the  stomach  and  the  abdominal  wall 
and  cure  the  patient  permanently. 

(4)  We  now  open  the  stomach  purely 
to  explore  it  and  find  out  whether  or 
not  there  is  serious  disease.  This  has 
enabled  us  in  many  cases  to  relieve  ill- 
ness which  otherwise  was  incurable. 
Nearly  all  of  these  patients  recover 
from  the  operation. 

(5)  The  permanent  opening  in  the 
stomach  through  which  we  can  feed 
a  patient  I  have  already  described.  It 
was  first  proposed  in  1837.  It  was  first 
done  in  1849.  From  then  until  1875 
twenty-eight  cases  were  operated  on, 
with  twenty-eight  deaths!  It  seemed 
almost  as  though  the  operation  must 
be  abandoned  when,  in  1875,  the  first 
operative  recovery  occurred.  From 
then  until  1884  in  103  cases  there  were 
J  33  deaths— a  mortality  of  81.06  per 
cent.  At  the  present  time  the  mortality 
is  only  about  25  per  cent,  in  cases  of 
cancer,  and  in  the  non-malignant  cases 
not  over  10  per  cent. 

(6)  As  I  have  indicated,  in  certain  con- 
ditions we  make  an  opening  in  the  stom- 
ach and  another  m  the  bowel  and  sew 


16 


the  two  together.  In  some  cases  of 
ulcer  of  the  stomach,  which  cannot 
be  cured  by  medical  means,  this  gives 
wonderful  results,  both  as  to  comfort 
and  cure.  The  operation  was  first  done 
in  1881,  with  a  mortality  decreasing 
from  65.71  to  38.91  per  cent,  in  general, 
and  in  the  statistics  of  single  surgeons 
to  only  7.4  per  cent. 

(7)  The  first  removal  of  the  pylorus 
with  union  of  the  bowel  and  stomach 
was  done  m  1879.  The  mortahty  was 
very  great,  and  still  is  large,  ranging 
from  27.2  per  cent,  in  simple  cases  to 
72.7  per  cent,  when  there  are  extensive 
adhesions. 

(8)  When  the  pylorus  is  simply  nar- 
rowed, but  is  not  the  seat  of  cancer, 
we  make  an  incision  in  its  long  axis, 
seize  the  edges  of  the  incision  at  the 
middle,  draw  them  out  at  right  angles 
to  the  line  of  the  incision,  and  by  sewing 
them  in  this  position  we  widen  the  open- 
ing of  the  pylorus.  This  was  first  done  in 
1886.  Up  to  1894  the  mortality  was 
20.7  per  cent.  Recently  Carle  has  re- 
ported fourteen  cases,  with  a  mortality 
of  only  7  per  cent. 

(9)  In  not  a  few  disorders  the  stomach 
is  dilated  to  nearly  two  or  three  times 
its  normal  size.  In  these  cases  we  now 
take  a  "tuck"  in  it,  as  was  first  done 
in  1891.  Up  to  three  years  ago  fifteen 
such  operations  had  been  done,  with 
only  one  death. 

(10)  When  the  stomach,  instead  of 
being  dilated,  is  displaced,  we  sew  it 
fast,  and  practically  in  all  cases  re- 
covery follows. 

(11)  Sometimes  the  stomach  is  di- 
vided into  two  parts,  like  a  dumb-bell 
with  a  very  short  handle.  The  first 
operation  for  relieving  this  condition 
was  done  in  1893  by  making  an  open- 


ing in  each  half  of  the  stomach  and 
sewing  the  two  openings  together.  Up 
to  this  year  over  forty  operations  have 
been  done  for  this  condition,  with  only 
nine  deaths. 

(12)  Tumors  of  the  stomach  other 
than  cancer  are  rare,  but  since  1887  at 
least  seven  cases  of  tumor  have  been 
cut  out,  of  which  six  have  recovered. 

(13)  Partial  removal  of  the  stomach 
finally  led  to  its  complete  removal,  of 
which  over  a  dozen  instances  have  been 
reported,  with  a  recovery  of  somewhat 
more  than  half.  Nearly  all,  however, 
have  died  from  recurrence. 

Some  of  the  above  operations  are 
not  the  direct  result  of  experiment  upon 
animals  (as,  for  instance,  the  taking  of 
a  tuck  in  the  stomach);  but  they  are 
the  indirect  result,  first,  through  the 
antiseptic  method,  which  itself  is  the 
child  of  vivisection,  and.  secondly,  be- 
cause through  our  experience  in  other 
operations  we  have  been  led  to  perform 
totally  new  ones.  It  is  the  same 
in  other  sciences.  If  we  were  still  de- 
pendent upon  the  old  "air  pump"  worked 
by  hand  we  should  have  no  lighting  by 
the  incandescent  bulb  of  to-day,  for  this 
is  dependent  upon  a  cheap  method  of 
making  an  almost  complete  vacuum.  This 
is  a  wholly  unexpected  and  indirect  re- 
sult of  improvement  in  air  pumps  as  one 
of  the  chief  factors  of  progress. 
THE    INTESTINES. 

Very  much  the  same  story  can  be  told 
of  the  surgery  of  the  bowel.  Indeed, 
the  surgery  of  the  stomach  involves 
largely  that  of  the  bowel.  I  need,  there- 
fore, only  recall  a  very  few  points. 
When  a  tumor  or  cancer  exists  in  the 
bowel,  of  course,  in  a  little  while  it  ob- 
structs the  passage  of  the  intestinal  con- 
tents;   and    if   this   obstruction   becomes 


17 


complete  and  is  not  quickly  removed  the 
patient  must  necessarily  die.  As  a  re- 
sult of  many  experiments  upon  animals 
(more  especially  by  Senn,  Parkes  and 
other  American  surgeons)  we  now  know 
how  to  deal  with  this  condition.  First, 
if  the  tumor  or  cancer  can  be  removed 
it  is  cut  out  entirely,  and  the  two  ends 
of  the  bowel  are  united.  Our  present 
^successful  means  of  uniting  them  are  a 
result  of  most  laborious  researches  by  ex- 
perimentation upon  animals  to  discover 
the  best  method  of  doing  this  otherwise 
perilous  operation.  The  slightest  leakage 
of  intestinal  contents  produces  a  fatal 
peritonitis.  Where  the  cancer  cannot  be 
removed,  in  order  to  prolong  the  pa- 
tient's life  and  lessen  his  terrible  pains 
we  make  an  opening  above  the  obstruc- 
tion and  another  one  below  and 
sew  the  two  openings  together.  Here 
again  many  experiments  were  needed  to 
determine  whether  an  animal  could  live 
with  the  intestinal  contents  thus  "side- 
tracked," and  if  life  could  be  maintained, 
what  was  the  best  method  of  doing  the 
operation. 

In  gunshot  wounds  of  the  intestines, 
which  formerly  were  among  the  most 
fatal  of  all  accidents,  we  now  can  rescue 
a  very  large  percentage  of  the  patients. 
During  the  civil  war  practically  almost 
every  case  of  perforation  of  the  intestine 
by  gunshot  died.  To  see  whether  some- 
thing could  not  be  done  to  remedy  this 
frightful  mortality  Gross  many  years 
ago  performed  some  experiments  to  de- 
termine the  best  treatment  of  such 
wounds.  Later  Parkes  etherized  a  num- 
ber of  dogs,  shot  them,  opened  the  abdo- 
men and  treated  the  wounds  in  various 
ways;  and  in  consequence  of  this  and 
other  series  of  experiments,  at  the  pres- 
ent   time    many    instances    of    recovery 


have  been  reported  in  which  multiple 
wounds  even  to  the  number  of  seventeen 
have  been  found  closed  by  methods  de- 
termined by  vivisection  to  be  the  best, 
and  the  patients  have  recovered.  To 
reach  this  result  it  had  to  be  determined 
by  accurate  observation  on  animals 
what  was  the  best  method  of  closing 
such  wounds;  what  material  is  the  best 
for  use  as  a  thread;  under  what  condi- 
tions it  would  be  needful,  instead  of 
closing  the  wound,  to  cut  out  the  injured 
portion  of  the  bowel  and  unite  the  two 
ends:  how  long  after  perforation  oc- 
curred was  the  best  time  to  operate,  and 
many  other  such  questions  too  technical 
to  mention  here. 

In  typhoid  fever  and  in  ulcer  of  the 
stomach  also  sometimes  a  perforation 
similar  to  the  hole  made  by  a  bullet 
occurs,  and  the  contents  of  the  intestines 
or  of  the  stomach  are  poured  out  into 
the  abdominal  cavity.  Of  course,  every 
one  knoAvs  that  if  this  went  on  for  a 
brief  time  death  would  necessarily  fol- 
low. In  the  lower  animals  we  cannot 
produce  exactly  the  conditions  following 
gastric  ulcer  and  typhoid  fever;  but.  in 
consequence  of  the  knowledge  acquired 
by  experimenting  upon  gunshot  and  in- 
cised wounds  of  the  stomach  and  bowel 
in  the  lower  animals,  in  1884,  we  finally 
woke  up  to  the  fact  that  a  perforation 
after  such  an  ulcer,  either  in  the  stom- 
ach or  in  the  bowel  from  typhoid  fever, 
ought  to  be  closed.  In  156  cases  of 
such  perforation  of  the  stomach  opera- 
tion has  been  done,  and  the  recoveries 
have  been  46.80  per  cent.  But  in  the 
last  54  of  these  operations  done  from 
1896  to  1898  the  percentage  of  recoveries 
had  risen  to  64.82  per  cent.  In  158 
such  operations  done  for  perforation  of 
the  bowel  in  typhoid   fever  collected   in 


18 


1898  the  recovery  rate  was  23.41  per 
cent.  Siuce  then  it  has  risen  to  over 
one  in  three,  and  nltimately,  I  believe, 
one-half  of  such  patients  will  be  saved. 
It  must  be  remembered  that  in  such 
perforations  of  the  stomach  and  bowel 
every  patient  would  die  were  no  opera- 
tion done.  To  save  one-half  or  even  one- 
third  is  a  surgical  triumph, 

1  have  several  times  alluded  to  cut- 
tuig  out  a  portion  of  the  bowel  and  unit- 
ing the  two  ends.  This  involves  a  num- 
ber of  problems  which  ought  not,  and,  in 
fact,  cannot,  be  studied  in  man  because 
of  the  fact  that  it  is  wholly  inadmissible 
to  test  such  operations  (which  always 
involve  life)  on  man  when  they  can  be 
tested  accurately  and  more  quickly  by 
experiments  on  animals  and  without  in- 
volving human  life. 

I  have  stated  that  by  many  experi- 
ments on  animals  we  have  now  reached 
a  satisfactory  solution  of  the  problem 
how  the  two  ends  of  the  bowel  are  best 
sewed  together.  But  one  other  question 
was  still  unanswered — how  much  of  the 
bowel  could  be  removed  and  yet  life  be 
preserved.  A  similar  question,  we  have 
seen,  has  been  answered  in  respect  to 
how  much  of  the  liver  could  be  removed 
by  Ponfick's  experiments.  How  much  of 
the  bowel  could  be  removed  was  a  most 
important  question.  We  would  all  pre- 
sume that  a  few  inches,  possibly  even  a 
foot  or  tAvo,  might  be  removed  without 
danger;  but  when  we  remove  a  larger 
portion  we  cut  down  the  digesting  and 
absorbing  surface  to  such  an  extent  that 
it  is  a  question  whether  the  patient  can 
still  live.  This  has  been  determined 
upon  animals,  and  then,  as  occasion  re- 
quired us  to  decide  the  question,  in  man. 
As  a  result  of  the  knowledge  derived 
from  animal  experimentation  I  saw  four 


years  ago  in  Montreal  a  man  from  whom 
Shepherd  had  removed  over  one-third 
of  the  entire  length  of  the  bowel  (eight 
feet)  which  was  involved  in  a  large  tu- 
mor; and  yet  the  patient  was  in  capital 
health  a  long  time  after  the  operation. 

HYDROPHOBIA. 

The  search  tor  the  germ  of  this  dread- 
ful disease  has  as  yet  been  fruitless ;  but 
happily  the  search  for  the  means  of  pre- 
vention has  been  crowned  with  success. 
Of  every  hundred  persons  bitten  about 
fifteen  contract  hydrophobia,  and  of 
those  bitten  on  the  head  and  face  at 
least  80  per  cent,  die  of  hydrophobia. 
The  Pasteur  treatment,  which  is  entirely 
the  result  of  animal  experimentation, 
by  preventing  its  occurrence,  has  re- 
duced the  mortality  to  less  than  one 
per  cent.;  and  yet  the  establishment  of 
Pasteur  Institutes  for  the  benefit  of  the 
human  race  has  been  resisted  most  stren- 
uously by  those  opposed  to  vivisection. 

TRANSPLANTATION    OF     BONE. 

In  1867,  Oilier,  a  celebrated  French 
surgeon,  who  recently  died,  by  exper- 
iments on  animals  showed  that  the  mem- 
brane which  covers  the  bones  (the  per- 
iosteum) could  be  peeled  off  a  bone  and 
transplanted  to  a  distance  into  the  tis- 
sues of  the  same  animal,  or  even  of 
another  animal,  and  that  it  would  there 
live  and  produce  new  bone.  These  ex- 
periments, very  crudely  described  in 
these  few  words,  have  been  extraordi- 
narily fruitful  in  several  directions. 

First,  in  certain  cases  it  is  necessary 
to  remove  diseased  or  dead  bone.  These 
experiments  showed  us  that  if  in  remov- 
ing the  bone  the  periosteum  was  care- 
fully guarded  and  left  behind  it  would 
reproduce  the  bone.  In  some  cases  in 
which  the  lower  jawbone  has  died  as  a 
result  of  phosphorus  poison  in  the  eni- 


19 


ployes  of  phosphorus  match  factories, 
the  dead  bone  has  been  removed,  but 
the  periosteum  has  been  preserved  and 
a  new  jawbone  has  been  reproduced. 
Another  result  has  been  that,  instead 
of  amputating,  for  example,  an  arm 
when  the  elbow  is  diseased,  we  can  re- 
move the  bone  and  by  preserving  the 
periosteum  can  preserve  a  more  or  less 
useful  joint. 

In  other  cases  a  certain  area  of  bone, 
as,  for  instance,  in  the  skull,  is  chiseled 
loose  or  otherwise  separated  from  the 
surrounding  bone  excepting  for  an  inch 
or  two  at  the  portion  where  the  chief 
blood  supply  enters  the  flap.  The  bone 
is  then  forcibly  broken  at  this  unchis- 
eled  portion  and  turned  back,  the  perios- 
teum and  scalp  acting  as  a  hinge.  When 
the  tumor  has  been  removed,  the  abscess 
opened,  or  other  needful  operation  done, 
the  trap  door  is  simply  closed  by  replac- 
ing the  flap,  the  scalp  sewed  in  place 
and  the  integrity  of  the  skull  is  restored. 
One  can  see  that  this  is  an  immense  ad- 
vantage over  having  a  great  hole  left 
in  the  side  of  one's  skull. 

In  some  cases,  in  which,  in  conse- 
quence of  accident  or  abscess,  a  large 
hole  already  exists  in  the  skull,  we  either 
chisel  off  bits  of  adjacent  bone  or  take 
pieces  of  bone  from  one  of  the  lower 
animals  and  successfully  fill  this  opening. 

Again,  in  certain  cases,  for  example, 
in  which  the  jaw  has  been  fractured,  a 
bit  of  the  bone  has  been  chiseled  loose 
from  the  patient's  jaw  and  has  been 
grafted  in  place  as  a  bridge  between 
the  two  fragments,  so  relieving  the  de- 
formity or  remedying  an  otherwise  in- 
curable fracture. 

Again,  a  certain  small  number  of  chil- 
dren are  born  without  any  bone  at  the 
back   of  the    spine   in   the   neck    or    the 


loin  (spina  bifida").  Through  this  open- 
ing the  membranes  of  the  spinal  cord 
protrude  and  form  a  tumor  which,  if  un- 
treated, in  most  cases  proves  fatal.  We 
noAv  operate  most  successfully  on  many 
of  these  cases,  and  in  suitable  cases 
either  chisel  loose  a  bit  of  adjacent  bone 
and  transplant  it,  so  as  to  close  the  open- 
ing, or  in  other  cases  take  a  bit  of  bone 
from  one  of  the  lower  animals  to  fill 
the  opening  and  cure  the  patient. 

Again,  m  certain  cases  of  fracture  of 
the  arm  bone  (humerus)  the  nerve  going 
to  the  muscles  on  the  back  of  the  fore- 
arm, which  winds  close  around  the  bone 
in  a  spiral,  is  torn  in  two;  these  muscles 
are  paralyzed,  and  the  patient  has  what 
we  term  "wrist  drop,"  so  that  the  hand 
is  useless.  In  such  cases  the  knowledge 
derived  from  tAvo  different  series  of 
experiments  comes  to  our  aid  to  enable 
us  to  remedy  the  trouble.  First  we  find 
the  two  ends  of  the  broken  nerve,  freshen 
these  ends,  unite  them,  and  in  many 
cases  can  change  a  useless  hand  into 
a  useful  one;  but  if  so  much  of  the  nerve 
has  been  destroyed  that  the  two  ends 
cannot  be  brought  together  we  now  de- 
liberately remove  an  inch  or  two  of  the 
arm  bone,  thus  shortening  the  arm 
so  as  to  bring  the  two  ends  of  the  nerve 
together,  and  in  a  good  percentage  of 
cases  we  can  again  restore  the  hand 
to  usefulness  after  months  and  occa- 
sionally even  after  years. 

A  still  more  remarkable  transplanta- 
tion of  the  bone  is  accomphshed  in  some 
operation  on  the  skull.  In  some  cases 
it  is  necessary  to  remove  a  button  of 
bone  which  may  be  an  inch  and  a  half 
or  two  inches  in  diameter  in  order  to 
do  an  operation  on  the  brain.  The  op- 
eration which  has  necessitated  this  re- 
moval   of    bone    may    require    an    hour 


20 


and  a  half  or  two  hours.  If  we  want 
to  replace  the  bone  so  as  not  to  leave 
an  opening  in  the  skull  through  which 
the  brain  may  easily  be  dangerously 
injured,  we  put  it  in  a  basin  of  hot 
salt  solution  or  weak  antiseptic  solu- 
tion, and  by  keeping  it  at  a  proper  tem- 
perature, at  the  end  of  the  operation, 
when  it  has  been  totally  detached  from 
the  body  for  so  long  a  time,  we  re- 
place it  and  its  vitality  is  not  lost. 

All  of  these  various  operations  (and 
others  which  I  have  not  time  to  describe) 
done  on  bone,  to  the  immense  advantage 
of  our  patients,  are  the  direct  or  remote 
results  of  the  experiments  of  Oilier  and 
others  on  the  transplantation  of  perios- 
teum and  of  bone.  The  indirect  results 
are  quite  as  valuable,  and  sometimes 
more  valuable,  than  the  direct  results  of 
such   experiments. 

An  illustration  of  the  indirect 
results  of  Ollier's  experiments  is  shown 
in  the  transplantation  of  the  skin.  One 
of  the  oldest  operations  in  surgery  is 
the  making  of  a  new  nose.  When  the 
nose  has  been  lost  a  suitable  shaped 
flap  w^as  cut  on  the  forehead,  leaving  a 
sufficient  uncut  base  for  a  proper  blood 
supply  so  that  the  flap  would  not  un- 
dergo gangrene.  The  flap  was  then 
turned  by  twisting  it  on  its  base  and 
was  sewed  in  place  w^here  the  nose  had 
been.  The  experiments  of  Oilier  and  his 
successors  showed,  however,  that  perios- 
teum, and  even  so  dense  a  structure  as 
bone,  could  be  entirely  detached  from  the 
body  for  a  long  time  and  yet  not  lose 
its  vitality.  Hence  we  now  transplant 
bone  as  well  as  skin  to  make  firm  in- 
stead of  flabby  noses.  This  has  led  us  of 
late  years  to  apply  the  same  procedures 
to  the  skin,  and  enables  us  now  to  do  far 
more     extensive     and     more     successful 


operations  than  would  otherwise  have 
been  possible.  The  first  method  tried 
in  man  was  that  of  Ileverdin,  of  Geneva. 
He  cut  little  bits  of  skin  only  as  big 
as  a  pin's  head  from  the  arm  or  the 
thigh,  not  quite  skin  deep,  and  planted 
them  on  any  raw  surface  which  did 
not  heal  readily.  These  grafts  under 
proper  treatment  adhere  and  form  new 
centres'  from  which  healing  of  the 
wound  takes  place.  Emboldened  by 
this,  Krause  and  other  surgeons  have 
taken  very  large  pieces  of  skin,  includ- 
ing often  the  whole  thickness  of  the 
skin,  and  transplanted  them.  For  ex- 
ample, in  some  cases  of  extensive  can- 
cer in  Avhich  a  very  large  portion  of 
skin  must  be  removed,  now,  while  the 
patient  is  under  the  influence  of  the 
anesthetic,  we  take  strips  of  skin  an 
inch  wide  and  several  inches  long  from 
the  thigh,  or,  in  other  cases,  from  an- 
other person  who  is  willing  to  give  up 
a  portion  of  his  skin.  These  pieces  are 
immediately  placed  on  the  raw  place 
left  by  the  removal  of  the  tumor,  and 
as  they  do  not  lose  their  vitality  but 
grow  fast  to  the  tissues  under  them, 
the  wound  is  healed  almost  immediately, 
instead  of  taking  a  long  time  for  the 
slow  formation  of  a  scar. 

One  of  the  most  diflicult  of  all  wounds 
to  heal  is  an  extensive  burn,  such  as  is 
produced  by  the  clothing  catching  fire. 
In  these  cases  large  surfaces  of  the  skin 
on  the  chest  or  the  abdomen  slough  off, 
resulting  in  great  ulcers.  These  some- 
times take  months,  sometimes  years,  to 
heal,  and  in  not  a  few  cases  never  heal, 
no  matter  what  is  done.  Now,  as  a  re- 
sult of  our  experience,  first  with  the  per- 
iosteum and  bone  and  then  with  small 
bits  and  then  larger  bits  of  skin,  we 
transplant    strips    of    skin    as    just    de- 


21 


scribed,  and  heal  such  wounds  in  a  very 
short  time.  One  sees  in  the  newspapers 
every  now  and  then  accounts  of  some 
woman  whose  long  hair  has  been  caught 
in  machinery  and  almost  all  of  the  scalp 
torn  away.  These  wounds  are  healed 
by  transplanting  skin  in  a  similar  man- 
ner. 

THE  BLOOD. 

We  are  at  present  only  just  beginning 
to  appreciate  how  much  we  can  learn 
from  examination  of  the  blood,  especial- 
ly by  new  methods  lately  introduced. 
Almost  every  intelligent  person  knows 
that  the  blood  consists,  roughly  speak- 
ing, of  a  fluid  in  which  tioat  small  cir- 
cular disks,  about  1-3000  part  of  an 
inch  in  diameter,  called  the  red  blood 
cells.  In  addition  to  these  there  is  in 
the  blood  another  kind  of  cell  called  the 
white  blood  cell.  The  red  blood  cells 
are  made  up  chiefly  of  a  substance 
called  hemoglobin,  which  gives  the  color 
to  the  blood.  Some  of  the  investiga- 
tions, which  aie  really  only  at  present 
at  the  beginning  of  their  usefulness,  are 
as  follows.  They  are  good  illustrations 
of  how  inductive  science  begins  by  as- 
certaining facts.  If  they  are  valueless 
they  are  disregarded;  if  of  value  they 
are  studied  still  further.  It  is  not  un- 
likely that  the  blood  may  soon  be  one  of 
the  most  fruitful  sources  of  the  knowl- 
edge by  which  surgery  may  profit 
greatly: 

First,  the  number  of  white  blood  cells. 
It  is  found  that  in  case  inflammation 
results  in  an  abscess  the  number  of 
white  blood  cells  is  increased  several 
times.  Ordinarily  in  a  little  cube  of 
blood  one  millimeter  (the  twenty-fifth 
part  of  an  inch)  on  each  of  its  sides  the 
number  of  red  blood  cells  is  about  four 
to  five  millions,  and  the  number  of 
white  blood  cells  is  8000  to  10,000. 


If  one  has  an  abscess  the  white  blood 
cells  as  a  rule  will  rise  to  15,000,  20,000. 
25,000  or  more  to  the  cubic  millimeter — 
a  condition  that  we  know  scientifically  as 
"leucocytosis."  In  certain  cases  when  it 
is  a  question  whether  an  abscess  exists 
(as,  for  instance,  in  the  brain,  in  the 
liver,  and  other  parts  of  the  body  in 
which  the  diagnosis  is  very  diflScult  to 
make)  if  the  leucocytosis  or  its  absence 
will  show  us  absolutely  that  there  is 
or  is  not  an  abscess  present  it  would 
be  of  the  greatest  help. 

Again,  in  typhoid  fever  the  pain  and 
tenderness  exist  just  above  the  right 
groin.  In  appendicitis  the  pain  and 
tenderness  exist  in  the  same  region,  and 
in  not  a  few  cases  it  i»  extremely  dif- 
ficult to  distinguish  between  these  two 
diseases.  Especially  is  this  true  at  the 
beginning  of  such  an  illness,  just  when 
it  is  most  important  to  make  the  ri^rht 
diagnosis  and  institute  the  correct  treat- 
ment. If  the  presence  of  leucocyto- 
sis will  show  us  distinctly  that  it  is  ap- 
pendicitis, and  the  absence  of  leucocyto- 
sis that  it  is  typhoid  fever,  an  immense 
gain  in  accuracy  of  diagnosis,  and, 
therefore,  of  the  proper  treatment,  will 
result.  To  open  the  abdomen,  if  it  is 
typhoid  fever  (without  perforation), 
would  be  a  dreadful  mistake;  not  to 
open  it,  if  it  is  appendicitis,  would  be,  as 
a  rule,  equally  wrong  treatment.  If 
the  leucocytosis  is  a  sure  guide  we 
cannot  learn  it  too  quickly.  It  seems 
to  me  very  reasonable,  therefore,  that 
experiments  should  be  made  in  the  low- 
er animals  by  producing  abscesses  and 
determining  whether  under  many  vary- 
ing conditions  leucocytosis  is  always 
present  when  there  is  an  abscess  and 
always  absent  when  there  is  no  abscess. 
Second  Hemoglobin.— The  hemoglobin, 
which   makes    up   the    bulk   of   the    red 


22 


blood  cells,  is  the  means  by  which  oxy- 
gen is  carried  to  all  parts  of  the  tis- 
sues. Whenever  an  anesthetic,  such 
as  ether  or  chloroform,  is  given, 
the  amount  of  hemoglobin  is  distmctly 
diminished,  and  by  this  means  the  oxy- 
genation of  the  blood  is  hindered.  In 
certain  conditions  of  the  system  the  per- 
centage of  hemoglobin  is  diminished  to 
130,  50  or  even  as  low  as  25  of  the 
normal.  If  an  anesthetic  is  giv- 
en to  a  person  with  an  already  di- 
minished percentage  of  hemoglobin  this 
percentage  is  still  further  diminished, 
and  the  oxygenation  of  the  blood  still 
further  hindered.  If,  then,  the  percen- 
tage of  hemoglobin  is  very  small  before 
an  operation  the  danger  of  giving  an 
anesthetic  is  very  marked;  if  the  hemo- 
globin is  as  low  as  30  per  cent,  it  is  very 
likely  that  the  patient  may  die  upon  the 
table  irrespective  of  the  operation,  sim- 
ply because  the  anesthetic  reduces  the 
hemoglobin  to  such  a  point  that  the  blood 
does  not  absorb  enough  oxygen  to  carry 
on  life.  Some  authorities  have  stated 
that  we  ought  never  to  give  ether  or 
chloroform  to  a  patient  whose  hemoglo- 
bin is  below  50  per  cent.  Others  have 
placed  the  limit  as  low  as  30  per  cent. 
Surely  this  subject,  which  is  very  recent 
and  about  which  we  know  up  to  this 
time  very  little,  ought  to  be  investigated 
with  the  greatest  care  in  animals  rather 
than  to  decide  the  question  by  sacrificing 
life  by  venturing  to  give  an  anesthetic 
to  patients  whose  hemoglobin  is  at  so 
low  a  point  as  to  be  inconsistent  with 
safety. 

Other  recent  researches  are  those  on 
the  temperature  at  which  the  blood 
freezes  and  the  lapse  of  time  after  the 
blood  is  drawn  from  the  body  before  it 
coagulates — that  is,  clots.     A  small  por- 


tion of  blood  drawn  by  a  prick  of  the 
finger  enables  us  to  determine  these 
four  conditions — i.  e.,  (1)  the  presence  or 
absence  and  degree  of  leucocytosis; 
(2)  the  percentage  of  hemoglobin;  (3) 
the  freezing  temperature  of  the  blood, 
and  (4j  the  coagulation  time  of  the  blood. 
We  are  beginning  to  see  that  these  last 
two  as  well  as  the  first  two  will  probably 
prove  of  the  greatest  value  in  refer- 
ence to-  surgical  operations.  Hence  we 
ought  to  learn  accurately  and  quickly 
all  the  facts  in  the  case  by  experiments 
upon  animals,  and  so  avoid  dangers  to 
human  life  of  which  imtil  lately  we  have 
been   quite   ignorant. 

These  would  include  experiments  upon 
animals  fasting,  or  after  feeding;  after 
being  bled;  after  surgical  operations 
have  been  done  upon  them;  after  an  an- 
esthetic is  given  to  them;  when  the  an- 
esthetic is  administered  for  a  short  time, 
for  a  longer  time,  for  a  very  long  time, 
for  a  time  long  enough  to  kill  them,  in 
order  to  determine  what  the  effect  of 
the  anesthetic  is  in  fatal  and  non-fatal 
doses.  It  is  of  the  utmost  importance 
that  we  should  know  exactly  and  speed- 
ily the  result  of  all  these  conditions.  If 
we  are  debarred  from  learning  them  by 
experiment  on  animals,  then  the  human 
race  must  go  without  the  knowledge  ""'c 
seek,  saving  as  it  is  revealed  to  us  from 
time  to  time  by  studying  slowly  and 
inexactly  the  results  in  man.  With  cer- 
tain modifications  due  to  the  slight  dif- 
ferences between  man  and  animals  the 
conclusions  drawn  from  experiments  on 
animals  apply  to  man. 

Let  me  give  one  instance  which  con- 
fronts the  surgeon  not  infrequently.  An 
abdominal  section  is  occasionally  fol- 
lowed by  very  great  and,  it  may  be,  dan- 
gerous and  alarming  depression.  One  of 
the    most    difficult    things    to    determine 


23 


in  some  cases  is  whether  this  condition 
is  due  to  the  shock  of  the  operation  or 
to  internal  hemorrhage.  This  hemor- 
rhage differs  fi-om  that  which  may  fol- 
low an  amputation  or  removal  of  a  tu- 
mor from  the  neck,  etc.,  hy  the  fact 
that  it  is  concealed  within  the  abdomen, 
and  its  existence  can  only  be  inferred. 
If  the  patient  is  suffering  from  shock, 
stimulation,  heat,  quiet,  certain  drugs, 
etc.,  will  be  resorted  to  to  enable  him 
to  recover.  If  it  is  due  to  internal  hem- 
orrhage, we  must  instantly  reopen  the 
abdomen  and  tie  the  bleeding  vessel.  To 
do  the  latter  operation  when  the  pa- 
tient is  only  suffering  from  shock  might 
prove  fatal;  not  to  do  it,  if  hemorrhage 
is  the  cause  of  the  depression,  is  cer- 
tainly fatal.  Xo  one  not  a  surgeon  can 
appreciate  the  anxiety,  the  careful 
weighing  of  evidence,  the  intense  longing 
for  some  positive  means  by  Avhich  a 
correct  diagnosis  may  always  and  surely 
be  made,  which  every  surgeon  feels  in 
such  an  emergency. 

It  is  possible  that  by  examining  into 
the  presence  or  absence  of  leucocytosis, 
by  determining  the  percentage  of  the 
hemoglobin,  or  possibly  even  the  coagu- 
lation time  and  the  freezing  temperature 
of  the  blood  in  a  number  of  operations 
in  human  beings,  we  might  be  able  posi- 
tively to  determine  the  difference  be- 
tvreen  shock  and  internal  hemorrhage, 
but  only  after  making  many  blunders, 
each  of  which  would  cost  a  human  life. 
In  an  animal  we  can  open  a  blood  ves- 
sel in  the  abdomen  and  let  it  bleed  for 
a  longer  or  shorter  time,  and  determine 
positively  the  leucocytosjs.  the  hemo- 
globin, etc..  the  animal  meantime  suffer- 
ing nothing  because  it  would  be  under 
an  anesthetic.  Which  is  the  right,  which 
the  kindest,  which  the  most  humane  wav 


of  finding  out  the  truth?  This  is  an  il- 
lustration of  the  harmlessness  to  ani- 
mals of  such  experiments  and  their 
priceless  value  to  human  beings. 

EXPERIMENTS  TO  ENABLE  US  TO  MAKE  A 
RELIABLE  AND  SPEEDY  DIAGNOSIS. 

In  some  cases  in  which  the  diagnosis 
is  ditficult,  or  may  require  considerable 
time,  experiment  upon  animals  aids  us 
greatly,  and  so  is  of  immense  value  t'. 
man.  Thus  in  supposed  anthrax,  or 
wool-sorter's  disease,  a  most  dangerous 
malady,  by  inoculating  a  guinea  pig  with 
the  discharge  the  diagnosis  can  be  clear- 
ed up  quickly  and  proper  treatment  in- 
stituted. If  a  case  suspected  to  be  one 
of  bubonic  plague  arises  the  diagnosis 
can  be  established  within  24  or  36  hours 
by  a  similar  injection  into  a  rat  or  a 
guinea  pig,  the  apprehensions  of  a  com- 
munity (to  say  nothing  of  the  patient 
and  his  friends)  relieved  and  the  greatest 
damage  to  its  commerce  averted  by  dis- 
covering that  it  is  not  the  dreaded 
pestilence,  or,  if  it  is  the  plague,  by 
showing  the  necessity  for  most  stringent 
measures  of  prevention.  I  do  not  think 
any  community  will  or  ought  to  allow 
sympathy  with  the  unavoidable  suffering 
of  a  few  rats  or  guinea  pigs  to  weigh 
in  the  balance  for  a  moment  against 
the  safety  of  many  human  lives  or  the 
ruin  of  large  business  interests. 

An  amusing  instance  of  how  sentiment 
gives  way  before  affection  and  facts 
occurred  not  long  since  in  England.  The 
brother  of  the  Duke  of  Newcastle  was 
bitten  by  a  dog  supposed  to  be  rabid. 
The  Duke  was  a  Vice  President  of  the 
Anti-Vivisection  Society,  but  knowing 
that  whether  the  dog  was  rabid  or  not 
(and,  therefore,  whether  his  brother  was 
in  danger  or  not)  could  only  be  settled  by 
inoculation    experiments    upon    animals, 


he  took  the  dog  to  Mr.  Horsley,  iu  Lon- 
don, and  had  the  experiment  done. 

By  similar  means  anthrax  and  actino- 
mycosis (or  lumpy-jaw,  -svhich  spreads  to 
man  as  well  as  to  herds)  among  cattle 
are  diagnosticated  and  eradicated;  glan- 
ders in  horses  is  recognized  and  stamped 
out  and  tuberculosis  in  cows  is  eradi- 
cated, not  only  preventing  its  spread  to 
healthy  cattle  but  through  the  milk  to 
many  human  beings,  especially  young 
children,  whose  chief  diet  must  be  milk. 

By  similar  experiments  on  animals 
chicken  cholera,  hog  cholera,  Texas 
fever  and  many  other  diseases  of  cattle, 
sheep,  horses,  hogs,  poultry  and  other 
animals  have  had  their  causes  discov- 
ered and  the  means  of  prevention  or  of 
cure  demonstrated.  The  Reports  of  the 
Bureau  of  Animal  Industry  at  Wash- 
ington enter  into  these  in  detail.  Surely 
the  poor  animals  who  have  benefited  so 
greatly  from  such  experiments  should 
pray  to  be  saved  from  their  friends  if 
these  beneficent  researches  are  to  be 
prohibited. 

I  often  wonder  what  would  have  been 
the  influence  on  surgery  if  the  young 
man  who  first  took  ether  in  the  Massa- 
chusetts General  Hospital  on  October 
10,  181S,  had  died.  Morton,  it  is  true, 
had  experimented  on  some  dogs  first,  but, 
as  we  now  view  it,  very  inadequately. 
Had  this  patient  died,  would  not  the  use 
of  ether  have  been  deferred  for  years, 
possibly  even  till  now,  and  meantime 
the  human  race  all  over  the  world  have 
gone  on  suffering  the  horrible  tortures 
of  the  pre-anesthetic  days  and  all  our 
modern  progress  in  surgery  have  been 
prevented?  I  hardly  ever  look  on  my 
patients  in  the  blessed  ether  sleep  with- 
out being  impressed  with  the  confident 
audacity    of   the    earlier   operators    who 


dared  to  induce  a  sleep  so  like  that  of 
death  when  they  must  often  have  asked 
themselves  whether  the  patient  would 
ever  waken  or  whether  this  was  not  the 
first  stage  of  the  never-ending  sleep. 

If  the  sacrifice  of  the  lives  of  even  a 
considerable  number  of  animals  enables 
us  to  reach  the  benevolent  purposes  a 
few  of  which  I  have  described,  is  it  not 
plainly^  moral  duty  to  perform  them  so 
as  to  obtain  this  knowledge?  Is  it  not 
wrong  to  hinder  such  benevolent  re- 
searches? Especially  is  it  not  wrong  so  to 
hinder  research  when,  in  the  vast  major- 
ity of  instances,  animals  suffer  little  or 
nothing?  In  almost  all  experiments  not 
only  can  an  anesthetic  be  used,  but  in  all 
involving  difficult  and  dehcate  opera- 
tions it  is  essential  to  do  so;  for  it  is 
impossible  to  do  such  an  operation  on  an 
animal  struggling  from  pain.  Not  only, 
therefore,  does  sentiment  lead  the  vivi- 
sectionist  to  spare  the  animal  all  the 
sulfering  that  is  possible,  but  scientific 
accuracy  points  in  the  same  direction. 
A  very  few  experiments,  principally 
those  on  the  nervous  system  which  re- 
quire us  to  determine  the  presence  or  ab- 
sence of  sensation,  cannot  be  done  with 
an  anesthetic;  but  these  experiments  are 
few  and  far  between.  Some  ex- 
periments also  (for  instance,  those 
on  lock-jaw.  to  which  I  have  al- 
ready alluded)  by  producing  the  dis- 
ease, necessarily  make  the  animal  suf- 
fer; but  if  by  the  sufiiering  of  a  few 
animals,  human  beings  suffering  from 
lock-jaw  can  be  cured,  or,  still  better,  if 
we  can  learn  the  cause  of  the  disease 
and  so  can  prevent  it  from  attacking 
human  beings,  is  it  not  worth  the  suf- 
fering? The  infliction  of  suffering  is 
not  cruelty.  If  one  dear  to  us  meets 
with  an  accident  far  away  from  surgical 


aid  and  we  simr  a  horse  to  the  utmost, 
so  that  finally  it  drops  dead  in  the  fran- 
tic effort  to  bring  surgicai  assistance,  I 
am  sure  no  one  would  accuse  us  of 
cruelty,  although  we  had  inflicted  tor- 
ture upon  the  horse.  So  this  infliction 
of  pain  On  a  small  percentage  of  animals 
experimented  on  is  not  cruelty,  but  is 
the  greatest  kindness  to  other  animals 
and  to  a  much  higher  animal — man  him- 
self. 

I  have  been  able  in  this  paper  only  to 
select  a  few  illustrations  of  the  progress 
that  surgery  has  made  by  experimenta- 
tion on  animals.  Practically,  as  I  said 
at  the  beginning,  nearly  all  of  these  have 
occurred  during  my  professional  life,  and 
I  speak,  therefore,  of  what  I  know.  Al- 
though I  myself  am  not  a  vivisection- 
ist,  yet  I  could  not  do  the  work  I  do 
every  day  and  accomplish  results  I  do 
were  it  not  for  just  such  work,  of  which 
I  take  advantage.  In  view  of  these 
facts,  therefore,  how  unwise  it  would 
be  to  restrict  and  still  more  to 
abolish  such  life-giving  and  pain-saving 


results  of  vivisection,  especially  when 
the  animals  themselves  benefit  from 
these  experiments  fully  as  much  as  man. 
I  have  not  referred  to  any  of  the  older 
experiments,  such  as  those  remarkable 
experiments  of  Jones  on  the  methods  of 
tying  blood  vessels  in  the  early  part  of 
the  last  century,  nor  of  Sir  Charles 
Bell's  experiments  by  which  he  deter- 
mined the  functions  of  the  two  different 
roots  of  the  nerves  just  as  they  emerge 
from  the  spinal  cord,  nor  of  the  circula- 
tion of  the  blood  as  discovered  by  Har- 
vey. All  these  are  fundamental;  and 
without  the  knowledge  derived  from 
them  we  should  be  a  century  or  more 
behind  where  we  are  now.  I  have  pre- 
ferred rather  to  take  modern  instances 
with -which  I  am  personally  familiar  in 
order  to  illustrate  the  subject  which  I 
have  been  asked  to  describe.  I  cannot 
believe  that  any  unprejudiced,  fair- 
minded  reader  will  not  agree  with  me 
that  such  humane  purposes  should  be 
fostered  and  not  hindered;  should  be 
encouraged  and  not  abolished. 


26 


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